Provider Demographics
NPI:1649349911
Name:TRI COUNTY OB GYN ASSOCIATES PLC LLC
Entity type:Organization
Organization Name:TRI COUNTY OB GYN ASSOCIATES PLC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-222-5558
Mailing Address - Street 1:1023 NEW MOODY LN STE 103
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9179
Mailing Address - Country:US
Mailing Address - Phone:502-222-5558
Mailing Address - Fax:502-222-3040
Practice Address - Street 1:1023 NEW MOODY LANE
Practice Address - Street 2:TRI COUNTY OB GYN ASSOCIATES INC SUITE 103
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9179
Practice Address - Country:US
Practice Address - Phone:502-222-5558
Practice Address - Fax:502-222-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65935884Medicaid
KY2438489000OtherPASSPORT ADVANTAGE
KY1149112OtherAMERIHEALTH
KY65935884Medicaid
KYDC9357Medicare PIN